Assessment of Aortic Root Size in Donor Heart Predicts Short and Long Term Recipient Outcomes after Orthotopic Heart Transplantation

Abstract

Orthotopic heart transplant (OHT) donor selection has broadened due to increased demand for suitable donor hearts. The gold standards for matching donor and recipient remain height and weight. Studies for donor-recipient matching are over 20 years old, indicating a need for a modern review of current matching criteria. We aim to evaluate the outcomes relationship in transplant donor-recipient selection based on aortic root diameter (ARD). We performed a retrospective chart review of all patients from 2014 to 2019 who underwent OHT (n = 120). Patients were excluded if donor records were not available. A total of 108 charts were analyzed. Donor and recipient ARD and index, height, weight, gender, age, and BSA were recorded. Endpoints were all cause mortality and primary graft failure. Single and multi-variate Cox proportional hazard models were utilized to identify predictors of survival. Kaplan Meir curves were utilized to illustrate recipient outcomes. Our cohort included 85 (78%) male and 23 (21%) female patients. Donor weight (P=0.03), donor height (P=0.005), and ARD size (P=0.015) were significantly associated with increased mortality. 7 (6.5%) patients had primary graft failure. Difference in recipient and donor BSA was significant when evaluating graft failure (p=0.044), hazard ratio of 3.42 (95% CI 1.03, 11.38). Multivariate analysis demonstrated increasing ARD was associated with mortality (Fig 1). When controlling for difference among donor-recipient pairs, ARD remained significant despite BSA (P=0.02), height (P=0.04), or weight (P=0.018). Donor ARD is associated with recipient survival in this single center study. Compared to standard donor-recipient evaluation parameters, donor ARD remained significant when evaluating death in multivariate analysis. Further multi-center assessment is warranted.